The efficacy and safety of vonoprazan–amoxicillin dual therapy in eradicating Helicobacter pylori: a systematic review and meta-analysis

AIM: To evaluate the efficacy and safety of vonoprazan–amoxicillin (VA) dual therapy for radically eradicating Helicobacter pylori (H. pylori). METHODS: The PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched up to July 7, 2022, to identify clinical trials comparing the efficacy of VA dual therapy and triple therapy for H. pylori eradication. After evaluating the quality of the included studies, random effects models were conducted, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to estimate the efficacy and safety of each approach. RESULTS: Six publications (including four randomized controlled trials) involving 2019 patients were included in this meta-analysis. Overall, the eradication rate for VA dual therapy was 89.9%, while it was 85.2% for triple therapy based on other acid inhibitors. The eradication rate of H. pylori in the VA dual regimen group was higher than that in the PPI-based (omeprazole or lansoprazole) triple therapy group (RR = 1.15, 95% CI 1.07–1.23, p < 0.0001). However, the efficacy of VA dual therapy was comparable with VA–Clarithromycin (VAC) triple therapy (RR = 0.97, 95% CI 0.93–1.02). Besides, the incidence of adverse reactions in VA dual therapy was also lower than that in triple therapy (RR = 0.80, 95% CI 0.70–0.91, p = 0.0009). CONCLUSION: Compared with PPI-based triple therapy, VA dual therapy showed a better therapeutic effect, safety and patient compliance rate for eradicating H. pylori, which should be used as a novel curative strategy in the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40001-023-01249-6.